RESEARCH ARTICLE

Implementation of an Interdisciplinary, Team-Based Complex Care Support Health Care Model at an Academic Medical Center: Impact on Health Care Utilization and Quality of Life a11111

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Christine Ritchie1,2*, Robin Andersen3, Jessica Eng1,4, Sarah K. Garrigues1,2, Gina Intinarelli3, Helen Kao3, Suzanne Kawahara1,2, Kanan Patel1,2, Lisa Sapiro3, Anne Thibault3, Erika Tunick3, Deborah E. Barnes1,2,5* 1 Department of Medicine, University of California San Francisco, San Francisco, California, United States of America, 2 Tideswell at UCSF, Division of Geriatrics, University of California San Francisco, San Francisco, California, United States of America, 3 UCSF Health, University of California San Francisco, San Francisco, California, United States of America, 4 Geriatrics, Palliative and Extended Care Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, United States of America, 5 Research Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, United States of America

Citation: Ritchie C, Andersen R, Eng J, Garrigues SK, Intinarelli G, Kao H, et al. (2016) Implementation of an Interdisciplinary, Team-Based Complex Care Support Health Care Model at an Academic Medical Center: Impact on Health Care Utilization and Quality of Life. PLoS ONE 11(2): e0148096. doi:10.1371/ journal.pone.0148096

* [email protected] (CR); [email protected] (DEB)

Editor: D William Cameron, University of Ottawa, CANADA

Introduction

Received: August 25, 2015 Accepted: January 13, 2016

Abstract

The Geriatric Resources for the Assessment and Care of Elders (GRACE) program has been shown to decrease acute care utilization and increase patient self-rated health in lowincome seniors at community-based health centers.

Published: February 12, 2016 Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. To minimize the risk of loss of privacy for older patients, age has been truncated to a maximum value of 89 years. We do not have IRB approval to provide specific ages for patients age 90 years or older. Funding: Evaluation of Care Support was supported by a grant to TideswellTM at UCSF from the S.D. Bechtel, Jr. Foundation. The SCAN Foundation provided support for the training and implementation assistance provided by the Indiana University

Aims To describe adaptation of the GRACE model to include adults of all ages (named Care Support) and to evaluate the process and impact of Care Support implementation at an urban academic medical center.

Setting 152 high-risk patients (5 ED visits or 2 hospitalizations in the past 12 months) enrolled from four medical clinics from 4/29/2013 to 5/31/2014.

Program Description Patients received a comprehensive in-home assessment by a nurse practitioner/social worker (NP/SW) team, who then met with a larger interdisciplinary team to develop an individualized care plan. In consultation with the primary care team, standardized care protocols were activated to address relevant key issues as needed.

PLOS ONE | DOI:10.1371/journal.pone.0148096 February 12, 2016

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Interdisciplinary Team-Based Care Support Implementation

Geriatrics GRACE Training and Resource Center to the UCSF Care Support program. The SCAN Foundation – advancing a coordinated and easily navigated system of high-quality services for older adults that preserve dignity and independence. For more information, please visit www. TheSCANFoundation.org. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist.

Program Evaluation A process evaluation based on the Consolidated Framework for Implementation Research identified key adaptations of the original model, which included streamlining of standardized protocols, augmenting mental health interventions and performing some assessments in the clinic. A summative evaluation found a significant decline in the median number of ED visits (5.5 to 0, p = 0.015) and hospitalizations (5.5 to 0, p25 days of follow-up, of whom 25 had disenrolled or died during the observation period.

Process Evaluation Patients, Process and Fidelity. Demographic characteristics of Care Support patients are shown in Table 1. Patients had a mean age of 65 years at enrollment; 60% were women, 85% had at least a high school degree, and 26% were living alone. Younger patients were more likely than older patients to report fair/poor self-rated health (85% vs. 55%, p

Implementation of an Interdisciplinary, Team-Based Complex Care Support Health Care Model at an Academic Medical Center: Impact on Health Care Utilization and Quality of Life.

The Geriatric Resources for the Assessment and Care of Elders (GRACE) program has been shown to decrease acute care utilization and increase patient s...
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